Archive

Speech Pathology

Things have been kinda crazy busy around here. We finished sleep school a week ago and Benji’s sleep is improved slightly, though he’s still waking up about 3 times in the night (down from about 10). We have also decided to make some bold changes such as hiring a nanny instead of sending him to daycare when we’re at work I’m also now back at work 3 days a week which makes the weeks go by even faster.

And speaking of time whizzing by, in less than 2 months, we’re going to celebrate Benji’s first birthday! How did it happen so quickly??? I’ve jut started thinking about the guest list and looking for baby-friendly cake recipes. Exciting times!

I’ve also been blogging more on www.speechiespeaks.wordpress.com about more speech and language related topics. Here’s one that I just published yesterday that might be of interest to some of the moms with young ones who read this blog:

Baby B, is now 10 months old. Physically, he is still little; he is very small for his age (5th percentile in weight, and 20th in height). But physical issues aside, his developments in cognition, language, and motor skills the last few months have been anything but little!

At 10 months, he is now able to interact with us in more familiar ways, such as:

making eye contact

reacting when his name is called

babbling, sometimes with some prosody and intonation that sound almost like he’s trying to speak in sentences

Most recently, in the last week or so, ..he also started saying “ma-ma-ma-ma”: much to my delight, though still not meaningfully (but we’ll get there!!!).

Now that he’s older, his toy box is also growing. Gone are the days where a playgym or a couple of hand held toys would preoccupy him for hours. He’s so much more active in every way and I’m having heaps of fun playing with him at his level, trying to encourage overall development. Yes, we’re talking SPEECHIE STYLE play. 🙂

If you are interested, here are some suggested play/language activities for your little 6-12 month old babies. Keep reading further for the bilingual edition.

Ball

This is quite possibly Baby B’s favorite game at the moment. He LOVES chasing after the ball. He enjoys it when we get involved, too, by rolling the ball to him and watching him throw it back to us. This is one activity I often do with kids on the autism spectrum who typically lack joint attention skills, to explicitly teach and show them the concept of turn taking and paying attention to others.

For Baby B and babies this age, this simple to and fro activity encourages joint attention and turn taking abilities, two very important pre-verbal and early interaction skills. Research has found correlation between strong joint attention skills and early receptive language abilities (Mundy & Gomes, 1998), and may even predict language development from about 6 months (Morales, Mundy, & Rojas, 1998) (both cited in Morales, 2000).

I like to add in language to describe what you’re doing. E.g., say “Mummy’s rolling the ball to XX” and when the kid catches it, go “Good catch! Now mummy’s turn!” and gesture for the kid to roll the ball over. You can expand the language even more by labeling the ball (size, color).

Peek-a-boo

It’s really incredible how tireless Baby B and other babies seem to be of playing peek-a-boo. We probably do various renditions of this game two or three times at any given day.

Even outside, Baby B would use his stroller blanket to initiate play with me. To encourage and acknowledge his initiation, I respond, even if I look really silly pushing a stroller and making weird, animated faces and gestures back at him.

Stacking blocks

These knock knock blocks are great – soft, colorful, and textured. .

While Baby B’s not yet at the stage where he’s stacking blocks, I enjoy showing him how to do it. When stacking, I’ll use language containing words such as “up,” “over,” and since he’s learned to topple the tower (with a cheeky grin!), I’ll describe the motion of blocks falling down so he is also introduced to the concept of opposites like “up” and “down.”

Blocks are also great to introduce other words defining positions: prepositions such as (the aforementioned) up, over, down, and also above, beside, between…you might think it’s ridiculous to start telling/teaching your child these words at 10 months but they have actually been found to be part of the first 20 words learned/used by English speaking children (Brown, 1973).

Touch and feel/ peek-a-boo books

I won’t comment or elaborate too much professionally on sensory input/integration in children; that’s the Occupational Therapist’s arena. However, I can talk about how the littles ones enjoy absorbing the sensory input they get from tactile books. This also allows for, yes!, more language building opportunities! We can talk about how things FEEL – and add to the adjective directory of your child’s vocabulary. For instance, does the book feel: soft, bumpy, prickly,…?

I’ll also elaborate more on how/why you need to keep reading books to your child.

Between 6-12 months, infants can already grasp the concept of books and actions associated with this activity. For instance, using their little fingers to touch and feel tactile books. Baby B has been introduced to these books very early on, and now he will automatically use his fingers to feel pictures everytime he sees a new book, regardless of whether it’s a touch and feel book in anticipation of some sensory input. Between 10-15 months, your child should also know to turn the pages of books, and less and less, put books in their mouths immediately.

With peek-a-boo books (those with flaps), your child should thoroughly enjoy pulling down the flaps to see what lies underneath – again, and again, and again…

As a speechie, I’ll also add: Keep reading to your child; spend sometime everyday to read a book or two, even if you’ve read them before. You can describe pictures, label people, places, actions, sounds, or even make up a new story around the pictures in the books. Bottomline: You can never talk too much to your baby. And better do it now when they still won’t mind it. :-p

Hand puppets

These are great toys to introduce to babies the concept of real vs pretend/imaginative play. We know that for the next few years, the child should engage in pretend play. Countless research has also remarked on the salience and benefits of pretend play in cognitive and language development (Bergen, 2002). Currently, Baby B loves the puppet frog we have, and is amused whenever I turn on a different voice for the puppet. He seems to realize that the puppet frog’s voice is mine and that I’m “pretending” to be that puppet frog, controlling its movements.

For a child who is language delayed, they might get this pretend play, and even if they don’t, they might be somewhat intrigued/confused by it. Either way, you have a pretty good shot at getting their attention with puppets. Then, once you’ve commanded their attention, continue on the play and continue to draw the child’s attention to what you’re doing.

Making “music” with boxes, plastic blocks

As infants around the 8-12 month age range start copying movements, I like to facilitate that more and more. Copying enables us to learn from each other, and interact effectively; and, yes, this skill starts very early in life!

I try to show babies, and toddlers in therapy, that sounds can be made by hitting on cardboard boxes or banging two plastic blocks together, and then see what they can do with that. Try to do a few beats here and there, and then as they grow older, do more sophisticated, rhythmic beats. Sometimes you can even pretend to hit the boxes, but use your voice instead to sound the rhythm. Showing the child that objects can make sounds, and then encouraging the child to also make them with their voices, is all part of language development.

At this stage, Baby B enjoys hitting two plastic toys together, and sometimes also banging on boxes or pots and pans (Gulp!! So noisy!). Sometimes I’ll chime in by singing a song and then hitting on the box to the rhythm of the song. (Yes, I took music classes – could you tell?) This is to make the whole learning experience more fun and enjoyable.

Imitate your child’s babbles

I have to be careful here when I say this…when your child is still babbling, you can and should imitate your infant’s babbles in response. BUT, when they start speaking, they will mispronounce words as their sound systems are still developing – do not imitate those incorrect productions. Instead, model correct words and sounds, regardless of how cute their productions are. E.g., Child says “nana” for “banana.” Model the word correctly for your child “Oh, I think you meant “BAnana” instead of continuing to use “nana.”

Why, then, do you want to imitate your infant’s babbles? Because they haven’t yet learned to meaningfully attach words or babbles to things/feelings/actions. They’re still exploring sounds they can make with their mouths, so encourage that!

Besides imitating, I also like to throw in a few new sounds for Baby B to see and learn. E.g., he’s now babbling with the “b” “d” and “m” consonants. I throw in an “f” or “v” or even some Mandarin only consonants so he hears them and hopefully explores and tries to produce them.

Baby sign

I haven’t been as vigilant about using baby sign, but now that he’s starting to imitate hand gestures and movements, I have resurrected my goal to teach him a couple signs. Baby sign comprises of meaningful gestures designed to teach babies to communicate efficiently their wants and needs. Because baby sign is not a language – in that it does not have any grammatical structures or markers – it is not intended to replace verbal skills, but to complement it.

The idea behind baby sign is that since babies typically learn to attach meaning to gestures earlier than they can use verbal language meaningfully, why not teach some simple signs so they can communicate more efficiently at an earlier stage.

Baby sign can be especially useful for children who are speech and language delayed. If your child is still not babbling or using one-word utterances by 12 months, you should seek professional help for an assessment and might also like to look into trying to teach your baby some signs to facilitate communication.

***Bilingual Edition***

If, like me, you speak another language and hope to raise your child to speak more than one language, NOW is the time to immerse your child in that other language. New research has shown that infants as young as 10-12 months start picking out the sounds of their native language and discarding those that are not (Kuhl, 2012, presentation on TED).

If the other language you speak is a less preferred one, then more effort has to be made to remember to use it with your child. Everyday, I do have to consciously remind myself to speak to Baby B in Mandarin for at least a couple hours. Because Baby B’s dad does not speak the language, I try to do it mostly when it’s just me and Baby B.

Basically, I try to do all the above play activities in English and the other language. For my own sake, I tell myself to speak only the other language at a certain time in the day. And outside those hours, I sometimes also pepper my speech with it. Recently, I’ve also borrowed and bought Mandarin books to read to Baby B in that language. Mandarin books and songs on the iPad also help remind me to use this language more to Baby B.

Who knew there’s already so much you can do with an infant! 🙂

Hopefully, this installment has been useful to some of you new moms out there and/or moms who are concerned about your child’s speech and language skills.

What other ways do you try to develop your infant’s communication?

References:

Bergen, D. (2002). The role of pretend play in children’s cognitive development. Early Childhood Research andPractice 4(1).

Brown, R. (1973). Development of first language in the human species. American Psychologist 28(2): 97-106.

So last week, I spilled the beans in my post about sleep training Benji, that, at 7 + months, he was not yet babbling. To most parents, this might not be alarming and if a parent were to ask me if they should be concerned about their child’s speech then, I would say “keep an eye and ear out for it, but it’s still too early to sound any real alarm bells.” But to me, a Speech-Language Pathologist parent, this was quite possibly one of the top things I was concerned about (along with his sleep and eczema). In fact, I was already keeping a keen ear out for babbles since he was about 5 months old, which is the time when most babies develop this skill. All I got were vocalizations; admittedly, they were pretty good ones with lots of variance in pitch and volume. But no babbles. He wasn’t even doing any raspberry kisses, which a lot of babies would’ve already done.

I did not express my concern to many people, who I know would’ve just brushed aside my concern and say I’m being an overeager parent (which is true). (My younger brother also had a history of some speech and language delays growing up so I do have some grounds for concern here, although he speaks and writes beautifully now.) On the quiet, though, I was doing all sorts of “therapy” with him. By that, I mean simply using different ways to teach him consonant sounds, since I have that knowledge, and since it’s not exhausting and won’t harm him in any way. Besides the usual reading to him and doing play therapy with him (making animal noises, sounds with cars, buses, etc.), I also at times would babble to him when he started vocalizing. I also used cued articulation, a visual system where a sign is attached to a consonant sound, to highlight the “p”s and “b”s with him, and whenever he stuck his tongue out at me – which was promising, it showed me he was aware of this articulator in his mouth and manipulating it – I would stick it back at him and then proceed to babble “la-la.” Meal times were the best to “show” him “how” to babble because he could focus and would have the most opportunity to look intently at my mouth as I used food to entice him.

Finally, I also used bits from the PROMPT method to show him and let him feel how he could make the “b” and “p” sounds, mostly doing it when he was already vocalizing. After 2 months of doing all that, one day last week, when Bry took Benji out, I got a text message: “Your son is babbling. I heard him do “la” and “da.” Always the skeptic, I wanted to make sure what he did not mishear, and asked: “Did you see his tongue and lips move to do that?” Bry replied tersely “yes, I have a video.”

Shortly after they returned and I viewed “the evidence,” Benji started going “ba-la-ba” and the Speech-Language Pathologist mom that I am cracked a huge grin and planted kisses everywhere on his face. “Great babbling!! Keep going!!! It is the most beautiful sound in the whole wide world!” I told him. You see, he wasn’t just doing reduplicated babbles, which features just one consonant in a string of babbles (e.g., “bababa”), he was doing variegated ones, a more complex version consisting of more than one consonant (e.g., “balada”). I was ecstatic; I think his speech is where he should be now!! Was it the therapy? Or was it just “his time”? Who cares!?!! He is babbling and that’s all that matters.

About a week after, my heart still melts whenever he starts “talking”. I’m pretty sure his first word will bring tears to my eyes.

Omg. There are so many thoughts racing through my mind as I read this.
For one, it would be a total hit with friends and family.
I could also totally see myself using this in the near future with birthday parties for Benji.
It would also be super for speech-language pathology therapy sessions around language:vocabulary building (gotta name the types of furniture), sequencing (steps needed to make the waffle batter), descriptors (sprinkles/colors/taste).
How very exciting. I just have to figure out how to get my hands on this fun toy.

PS: If you haven’t already, check out Whollykao’s blog it’s full of creative and fun posts (Whollykao was one of the WordPress featured sites not too long ago).

I just saw this on Design Sponge and had to post it. It’s a waffle iron that cranks out a set of miniature waffle furniture. And you can decorate the pieces however you want. The question is: breakfast decor (aka fruit and syrup), or dessert decor (sprinkles, chocolate, whipped cream). Perhaps the answer is both!

This waffle iron was concocted by designers Ryosuke Fukusada and Rui Pereira. You can read more about it here. Now…when can we buy one?

The Texas-shaped waffle iron may have just been one-upped by this furniture one!
(photo by Sew Caroline)

Benji’s coos are getting louder and louder, and his repertoire continues to increase. Between now and the next couple months he should start babbling. Meaning, he should start adding some consonants to his sound system (e.g., saying “bah-bah” and not just “ah”). These days, his crazy mom has been babbling lots to him using all the consonants in the English sound system. At times, I have also been babbling using Mandarin consonant sounds. When I do that, I notice Benji’s eyes attentively looking at my mouth, watching how it purses and releases, or how my tongue lifts and drops. It’s fascinating watching him watch me or his dad when we speak.

Reading has also become very much a routine in our household. No matter what we do, we try to read at least one book a day to him. Some days, I don’t even read the words in the book but just take a book and look at the pictures and describe them. At this age, it’s not so much the content; it’s more the act of reading. In fact, I also highly recommend picture books to parents because that gives parents the freedom to label the picture and even come up with an imaginative story themselves. (It’s also a great way to facilitate narrative skills in toddlers or pre-schoolers who cannot yet read.)

Language – speaking and listening – is the foundation for reading. A lot of parents don’t realize that, but a lot of kids who eventually go on to be good readers (except the ones who are diagnosed with dyslexia) have a good background in language. They know how to speak and understand and know how to manipulate sounds (e.g., do rhyme). That’s why when you look at speech development checklists from health nurses or pediatricians, they often ask if your child is babbling or using a variety of different sounds. This is agood speech and language development checklist I found for parents with infants or toddlers if you don’t already have one.

The first time I read a book to Benji, I’ll read the words. I use my finger to track the words I’m reading so he pays attention to the print. After that, I read the same book over with him for the next week or so (I usually have about 2 – 3 books in rotation during the week) and try other ways to explore and read to him from the same book. Here are some:

Labeling things in the book. When we read the same book again – and we do, many times over – I look for other things to talk about in the book. There are lots of other things to talk about: the color of the boy’s shirt, or the type of dog, etc. Repetition is a great way to help a child learn new words.

Playing silly word rhymes, e.g., when I see a page that says “7 pups pounce…” I go “and 7 pups bounce!” (even if they’re not part of the page) and “7 pups hounce,,,” Yes, “hounce” is not part of the English lexicon but it rhymes with pounce and bounce, and that is what I want to expose him to. Word games can be so fun and educational at the same time. Little kids especially from their toddler years LOVE them. Most little kids innately find silly rhymes funny (that’s why Dr Seuss books are such a hit!).

Using lots of action words when talking about the pictures in the books. E.g., “The puppies are pouncing!” “The puppies are rolling the colorful ball!” Nouns and action words are the first types of words that kids pick up, and it’s best to use the -ing version of the action word instead of just saying “He sits” say “He is sitting.” Developmentally, we want children to be able to use the “is + -ing” structure by around 2.5 years old (a lot of kids will developmentally say “He sitting” first and then progress to add the “is” in between). We also use slightly longer structures to extend the kid’s sentence structure, but not too long.

And as always, being animated and constantly moving because we know the little ones can’t sit still for too long.

Here are some other good websites to find suggestions on promoting literacy with your little one. Remember, language AND reading go complement each other. Read AND talk about the books with your little ones to get the best literary experience.

I hope I’ll never ever ever ever lose my passion for this job. I’m continually fascinated by the different disorders I deal with: there’s still so much out there to learn, and I get excited just thinking about possibilities. There’s also still so much advocating and educating of teachers and parents about best ways to work with children with speech, language and literacy difficulties, I still get excited thinking about this potential.

AND…of course, the kids – those mostly lovable, cute, innocent, and at times germy and annoying creatures. 🙂 They enthrall me the most. I truly believe that proper instruction and guidance can make a huge difference, especially when they have a language/speech delay or disorder…but It’s not always a walk in the park (especially when working for a big public organization); your best intentions may be met by resistance: you feel unappreciated at times by teachers and parents, bureaucracy gets in your way, and you butt heads with other people who have different agendas…it’s easy to be desensitized in an environment where making a difference or any significant change in a child, a system or teaching mentality is tough. It’s too easy to become jaded.

That’s why I look for little things to keep me excited about speech pathology (other than reading great research and talking to more knowledgeable and equally passionate speechies), such as…:

1. Thank you notes from students…

2. And having a like minded and fun coworker who also bakes! Getting that sugar rush from home made cupcakes (yum!) with personalized geeky IPA transcriptions…